Medical Clinic and Pharmacy


Student Immunization Form 

Minnesota Law (Minn. Stat.135A.14) requires students enrolled in a public or private post-secondary school in Minnesota be immunized against tetanus and diphtheria. The most recent vaccination must have been within the last ten years. Minnesota Law (Minn. Stat.135A.14) also requires students be immunized against measles, mumps and rubella (MMR). All doses of MMR vaccine must have been received after the age of 12 months. Students are exempt from this law if they were born before 1957, graduated from a Minnesota high school after 1996, or are enrolled in only one class or enrolled only in extension classes. To provide this information, students must complete a Student Immunization Form within the first 45 days of classes. Without this form you will not be able to register for subsequent semesters*.

To avoid a “registration hold”, complete the Student Immunization Form. You will need your StarID and Password to login to the system. Have your immunization information ready and follow the provided instructions to complete the form. When you submit the form your information will be electronically sent to the Immunization Coordinator on your behalf. Please note that when you register do NOT register thru your cart, instead use the QuickAdd function in registration. Otherwise the classes in your cart will continue to block the registration even after the hold has been cleared. If you would like to submit your records via FAX (320) 308-3192.

If you have questions/concerns about the current MN State law or St. Cloud State University's requirements regarding immunizations please contact the Immunization Coordinator at (320) 308-4855 or

*If you choose to do a medical or conscientious exemption you must print out the Immunization Form (pdf) then mail or FAX (320) 308-3192 the completed form to the Medical Clinic and Pharmacy.

Many of the documents on this page are .pdf files and require the Adobe Acrobat reader. You can Download Free Acrobat Reader here.




TdaP (diphtheria, tetanus, pertussis) Required .pdf
MMR (measles, mumps and rubella) Required .pdf
Hepatitis B
Meningitis .pdf


Additional Information

The Immunization Action Coalition has vaccine information in languages other than English.